Simplifying Psychiatric Documentation: Time-Saving Templates for Medication Recommendations

Simplifying Psychiatric Documentation

Time-Saving Templates for Medication Recommendations

Benjamin Rosen, MD

Virginia Fernandes, PharmD

Simplifying Psychiatric Documentation

Copyright © 2024 by Benjamin Rosen, MD

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author, except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law.

Tellwell Talent

www.tellwell.ca

ISBN

978-0-2288-7855-1 (Paperback)

978-0-2288-7854-4 (eBook)

Table of Contents

Antidepressants

Amitriptyline (ElavilR)

Bupropion (Wellbutrin SRR, XLR, ZybanR, AplenzinR, Forfivo XLR)

Citalopram (Celexa R)

Clomipramine (AnafranilR) for OCD

Desipramine (NorpraminR)

Desvenlafaxine (PristiqR)

Duloxetine (CymbaltaR)

Escitalopram (CipralexR, LexaproR)

Fluoxetine (ProzacR)

Fluvoxamine (LuvoxR)

Levomilnacipran (FetzimaR)

Mirtazapine (RemeronR)

Moclobemide (ManerixR)

Nortriptyline (AventylR, PamelorR)

Paroxetine (PaxilR)

Sertraline (ZoloftR)

Venlafaxine (Effexor XR R)

Vilazodone (ViibrydR)

Vortioxetine (TrintellixR)

Switching Antidepressants

Augmentation Agents for Depression/Anxiety

Aripiprazole (Abilify R)

Brexpiprazole (Rexulti R)

Bupropion (Wellbutrin XLR, AplenzinR, Forfivo XLR, ZybanR)

Liothyronine, T3 (CytomelR)

Mirtazapine (Remeron R)

Olanzapine (Zyprexa R)

Pregabalin (for comorbid anxiety, Lyrica R, Lyrica CRR)

Quetiapine XR (SeroquelR, Seroquel XR R)

Risperidone (RisperdalR, PerserisR, RykindoR, UzedyR)

Mood Stabilizers

Lamotrigine (Lamictal R, Subvenite R)

Lithium (Lithobid R, Carbolith R, Lithane R, Lithmax R)

Lurasidone (Latuda R)

Quetiapine XR (SeroquelR, Seroquel XR R)

Valproic acid (Depakene R) or Divalproex sodium (Epival R, Depakote R)

Antipsychotics

Aripiprazole (Abilify R)

Asenapine (Saphris R, SecuadoR)

Brexpiprazole (Rexulti R)

Cariprazine (Vraylar R)

Lurasidone (Latuda R)

Olanzapine (Zyprexa R)

Paliperidone (Invega R)

Quetiapine (Seroquel, Seroquel XR R)

Risperidone (RisperdalR, PerserisR, RykindoR, UzedyR)

Ziprasidone (Zeldox R, Geodon R)

Clozapine (ClozarilR, Versacloz R)

Long Acting Injectable Antipsychotics (LAI)

Switching LAIs

Sedatives

Lemborexant (DayVigoR)

Nortriptyline (Aventyl R, PamelorR)

Trazodone

Zopiclone (ImovaneR)

Zolpidem (AmbienR, Ambien CR R, SublinoxR, EdluarR)

Zaleplon (StarnocR, SonataR)

Stimulant Medication for ADHD

Amphetamine salts (Adderall XRR, MydayisR)

Lisdexamfetamine (VyvanseR)

Methylphenidate (ConcertaR, BiphentinR, FoquestR, Aptensio XRR, Cotempla XR-ODTR, DaytranaR, Jornay PMR, MethylinR, QuilliChew ERR, Quillivant XRR, RelexxiR, RitalinR, Ritalin LAR)

Non-stimulant Medication for ADHD

Atomoxetine (StratteraR)

Guanfacine (Intuniv XR R)

Anti-craving Medication for Alcohol Use Disorder

Acamprosate (CampralR)

Naltrexone (ReviaR, VivitrolR)

Medication Considerations in Pregnancy and Lactation

Antidepressants

Antipsychotics

Mood Stabilizers

Sedatives/Hypnotics

Management of Psychotropic-induced Adverse Drug Effects

Antidepressant-induced Sexual Side Effects

Antidepressant-induced Hyperhidrosis

Antipsychotic-induced Weight Gain

Management of Extrapyramidal Side Effects (EPS)

Antipsychotic-induced Hyperprolactinemia

Acknowledgments

References

Appendices

Appendix A: Prevalence of Adverse Events among Antidepressants

Appendix B: Recommendations for Metabolic Monitoring Patients on Antipsychotic Medications (ADA-APA guidelines)

Appendix C: Comparison of Long-Acting IM Antipsychotics – Second Generation Agents (Atypical)

Appendix D: Comparison of Long-Acting IM Antipsychotics – First Generation Agents (Typical)

Appendix E: Guide for Early and Late Administration of Long-Acting Injectable (LAI) Antipsychotic Medication

Appendix F: Psychopharmacology Drug Resource

USER GUIDE

This document is designed to streamline the clinical documentation of psychiatric pharmacotherapy recommendations for adult patients. It provides copy-ready templates that can be quickly adapted for clinical notes, covering medication initiation, dosage ranges, necessary investigations, and monitoring requirements. While the guide offers examples for generic patient scenarios, clinicians must tailor each template to the specific needs of their patients, particularly with respect to any required dose adjustments. Clinicians should consider factors such as age, health status, comorbidity, organ function, drug interactions, and patient preferences when making decisions. Tables and resources included are intended for reference only and should not substitute clinical judgment or individualized care. This document is not a substitute for direct consultation with a pharmacist or specialist, nor does it dictate treatment choices, but aims to save time in documentation by offering adaptable text.

Disclaimer

The authors endeavored to ensure the accuracy of the information presented at the time of creation. It is crucial to note that this information should not be considered a replacement for professional medical advice, and its exclusive reliance for managing complex patient cases is discouraged. In recognizing the dynamic nature of healthcare, the authors responsibly disclaim any liability, including negligence, and caution against potential loss, damage, or injury that may arise from the reliance on or use of the information contained herein.

Antidepressants

Amitriptyline (ElavilR)

I suggest starting amitriptyline 10 – 25 mg qHS for 5 – 7 days then increasing by 25 – 50 mg/day on a weekly basis to a maximum daily dose of 150 mg.

I reviewed the risks and benefits of TCAs including common adverse effects such as anticholinergic effects (dry mouth, constipation, blurred vision, urinary retention), sedation, GI upset, weight gain, and sexual dysfunction. Cardiovascular risks (orthostatic hypotension, tachycardia or palpitations, and ECG changes) were reviewed, as well as rare risks of induction of suicidal ideation, hypomania, GI bleed, and serotonin syndrome. Amitriptyline has evidence for the treatment of depression and pain. However, I note that TCA medications like amitriptyline have anticholinergic effects and so can be associated with urinary retention and constipation which may exacerbate pain. Amitriptyline has a narrow therapeutic index, and can be toxic in overdose. Toxicity can involve cardiovascular (arrhythmias), anticholinergic, and neurologic effects (seizures, coma). Drug interactions can be significant; therefore a full medication review is warranted.

Bupropion (Wellbutrin SRR, XLR, ZybanR, AplenzinR, Forfivo XLR)

I suggest starting Bupropion XL 150 mg QAM, and increasing to 300 mg after one week. Patient should then be reassessed after 4 – 8 weeks for adequate response.

I suggest starting Bupropion SR 150 mg QAM, and then increasing to 150 mg BID after 3 days. Patient should then be reassessed after 4 – 8 weeks for adequate response. If no clinical improvement, may increase to a maximum daily dose of 200 mg BID.

I have discussed the risks and benefits including agitation, insomnia, and worsened anxiety, as well as the rare risks of seizure (most commonly reported in overdose), arrhythmia,